Got to thinking about this today after I took a nursing exam and walked out boiling with high blood pressure!
Ok, so we have these tests in Process. Pharm and Assessment..not bad at all, but Process?? Ok, ok,......I know...they are "teaching us to think like nurses" and "there may be more than one right answer, but pick the BEST answer". I understand that nursing is not "black or white" but let's be real people??? The teachers don't know everything, but very few of them admit they don't! How many of you have questions on those tests that DO have TWO BEST ANSWERS??? Dare I say it?? Yes, Two RIGHT answers!! What I mean is, two answers that COULD BE right. The teacher did not weight one more heavily than other in lecture, but since you are learning to be a super nurse (right?), you know that, say, patient safety is more important than administering pain meds. So....... you pick that one on the test, the one pertaining to safety. OOOOPPSSS!!! Well, you were right on question #2 with that rationale but SORRY, on question #12 and #14 this is no longer the rationale. You can defend your answer to the grave. You see the teachers point, but darn it, you have a good point too. The teacher acknowleges that "yes, you could be right, you have a good point, your answer is not wrong, but what I say is right".:doh: It is TOTALLY INSANE. There are questions that I swear are just up to whatever the instructor wants that day. Everyone in my class swears she said one thing and then the next day she'll tell us that "oh no, X gets priority over Y" and then the next day, "well, you are right but Y gets priority over X" I mean, C'mon!! Anybody feelin' me on this??? :rotfl:
I mean, I AM critically thinking. I am doing what I am supposed to be doing!! I can fight why I answered what I did and they can fight why they say the right answer is the right answer. They will say neither answer is wrong, you could do both. Ok, then WHY WHY WHY is picking the answer about patient safety wrong? It's like on one test it is the right answer and then next test you get it wrong. I mean, isn't patient safety always your #1 concern??? DUH.:uhoh21: I swear, if I had a copy of the q's I got wrong, I would post them, just to see how many experienced RN's would get them right!!
Even getting past the stupid tests...the instructor is always right:rolleyes: . I have had an instructor agree with me that a question made no sense and was indeed misleading and then just say "Oh Well" and laugh and NOT give me any more points!!
Careplans??? We have two consecutive days clinical. One teacher (thank goodness for her) says that we could write up a preliminary care plan 1st day and she would correct. Then second day we would resumbit, corrected, the total care plan. This way, we would SLEEP the night before clinical and it would be safe for the patient. OH NO!!! Says the nursing department. "This is how it has always been" they say, and DEMAND that the whole entire careplan (25 pages) be done the night before clinical for 1st day. Doing this, students are taking 12-14 hours to finish the careplan and not sleeping. They acknowlege that this may not be safe for the patient, that it may be better to do careplan day 2 once you have done assessment, but won't change it. I mean, to give students only from 1pm on Wed to complete a careplan by Thurs 6 am, KNOWING it is going to take students almost 12 HOURS to complete and having the power to change that and NOT doing so.........well, that just seems like patient endangerment. It seems almost illegal!!
Anyway, the point I am making is that they often make things more difficult for no real good reason in nursing school. In fact, much of it is unfair while they pretend it is fair. I think it is all just a bunch of BS, a big huge "test" for the real thing. They treat you like crap, see how much BS you can take, so that you will be prepared for the real world. I get it, and there is no way getting away from it unless you GET OUT OF IT.:rotfl:
Funny.......police officers hold very important life or death positions too but they only have to be treated like crap and negated for 16 weeks. We have to do it minimum of two years!! I just hope I can do it. I hope I can suck down another not so good grade when I know I AM learning what I am supposed to be learning and my thinking is NOT incorrect. Ya just gotta bow down and take it.:bowingpur
Specializes in med/surg, telemetry, IV therapy, mgmt.
Actually, we each have a nursing care plan for every patient we care for--it's in our head. What everyone on this thread is talking about is the written version of the plan. Some states have laws requiring a written plan of nursing care be included in every single hospital patient's chart. With regard to the 25 page care plans, I did one that was 45 pages long in my BSN program. It was not only a care plan but an exercise in the use of references to back up statements made in the document. It is good preparation for graduate school is what we were told.
The reality of taking care of human beings is that you can do the "correct" thing ... and still have a crappy outcome. Perhaps a lot of nursing school BS is to begin to prepare you for this reality?
I really like the idea that that's the thinking behind a 25 page care plan. Unfortuntely I don't buy it, but I still like the idea :)
I loathe nursing diagnoses, and think that there is a disturbing trend toward assuming that nurses are idiots - if I don't know wihtout checking the plan that my rest-in-bed patient needs pressure care, chest physio and DVT prophylaxis then I do't think I can call myself a nurse.
That said, care plans have a place, and I don't think we can manage without them.
Care plans need to be on a chart to satisfy JACHO, in real life we do not use them it is just more nonsense paperwork. As far as nursing school goes I think most of the ADN is necessary and all the BSN is exactly that BS !
Care plans need to be on a chart to satisfy JACHO, in real life we do not use them it is just more nonsense paperwork. As far as nursing school goes I think most of the ADN is necessary and all the BSN is exactly that BS !
I shouldn't bite because if I didn't know better I'd say you're itching for a flamefest.
There is something very interesting about this thread. The younger nurses and nursing students think a lot of what is required in their nursing programs is not important. The older, experienced nurses have just the opposite view. They are defending the making of care plans! Why do you suppose that is? Perhaps the older, experienced nurses know a few more things than the students, hmmm?
From my old 1966 version of Webster's New World Dictionary, College Edition: "wisdom is the power of judging rightly and following the soundest course of action, based on knowledge, experience, understanding. . ."
I am an older (36) nursing student, will graduate this spring..
Our school calls careplans Nurse Process Papers (I think, from what I undertand of care plans)
I find them....dare I say it...fun.
Now, before I go farther, let me say that they are NOT 25 pages written the night before clinical. That might be a cool idea to at least know who your patient is going to be BEFORE morning report at clinical. What a concept But we do our NPP's and our dx's and interventions, evaluate outcomes and re-think. etc etc.
We were complaining last semester and the instructor said, this is where you learn to think like a nurse. She said maybe the nurses are not thinking in actual dx words (fluid volume, deficit, r/t....) but the WAY of thinking (critical thinking) is what is being taught on all these crazy papers. So I jump in with enthusiasm because I am thinking everything differently now and life is so much easier. (OK, trying to clean the fishtank using ADPIE was kinda weird but it worked lol)
I like learning the history, I love knowing that I am 'descended' so to speak, from a tradition of healing and holistic care. I love the fact that I am joining a profession, not just a job. I love knowing that when I do graduate, I will have an ingrained way of thinking that I owe to all these crazy, pain in the butt papers that I am writing, and that way of thinking will likely save someone's life some day.
Man I hate Care Plans. They are so dumb. I feel like a fraud every time I compile one because the wordage is so dumb. It's like when I try to speak spanish-it's obvious to all that the accent is terrible.
That being said, I busted out a care plan for my patient during clinical and scribbled it on my report sheet in about 15min. It's amazing how good you get at them. When my clinical instructor asked me what my plan for the day was I quickly described how I would remove the restraints frequently (risk for impaired skin integrity), assess resp status frequently (risk for asp-kid had swallowing impairment), etc, etc.
Last semester I also had a instructor who made us do 2 careplans a night which both were about 15-25 pages, depending on how many meds they were on (come on it's med-surg there's tons of meds!). We got out of clincal at 4pm. Those nights sucked, and yes, I was awefully tired in clinical the next morning.
But we do our NPP's and our dx's and interventions, evaluate outcomes and re-think. etc etc.
Daytonite, BSN, RN
1 Article; 14,604 Posts
Actually, we each have a nursing care plan for every patient we care for--it's in our head. What everyone on this thread is talking about is the written version of the plan. Some states have laws requiring a written plan of nursing care be included in every single hospital patient's chart. With regard to the 25 page care plans, I did one that was 45 pages long in my BSN program. It was not only a care plan but an exercise in the use of references to back up statements made in the document. It is good preparation for graduate school is what we were told.